RN Case Manager - Full-time

Ready to help us transform healthcare? Bring your true colors to blue. The Clinical Care Manager is responsible for facilitating care for members and families of members who may have rising health risks or reputed company healthcare needs, to promote optimal health. This position is self-directed and works independently and collaboratively to facilitate care based on the principles of care management. Facilitation is focused on assessing needs, identifying health care disparities, social determinants of health, and any barriers to care. This role is eligible for our eWorker, Mobile, and reputed company personas. The Team The Clinical Care Manager is part of a highly dedicated and motivated team of professionals, including medical and behavioral health care managers, dieticians, pharmacist, clinicians, medical directors and more, who collaborate to facilitate care. Key Responsibilities: + Engage members in appropriate plans of care, coordinate care and services as appropriate, communicate effectively and provide members with education and resources as needed. + Promote member compliance with treatment plan, encourage shared decision-making, and set appropriate goals to promote optimal member outcomes. + Interpret and apply case management criteria, processes, policies, and regulatory standards to create, follow and appropriately document comprehensive care management plans. + Review medication list and educate members with reputed company pharmacy needs, and counsel on reputed company effects and mitigation strategies for specific treatment protocols. + Successfully connect, engage, and maintain member engagement to support seamless care transitions and optimized health outcomes. + Interact with treatment providers, PCPs, physicians, therapists, and facilities as needed to gather clinical information to support the plan of care. + Monitor clinical quality concerns, reputed company referrals appropriately, identify and escalate quality of care issues. + Understand member insurance products and benefits, as well as regulatory and NCQA requirements. Key Qualifications: + Ability to identify and document member-driven, specific, measurable activities that address actionable behaviors and goals + Self-directed, independent, adaptive, flexible to change, and able to collaborate as a member of a team. + Proficient with multiple IT systems. + Demonstration of awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population. Education and Experience: + 3-5 years relevant experience in a variety of appropriate clinical health care settings (Inpatient, outpatient, or differing levels of care). + Utilization Management experience, preferred + Active licensure in Massachusetts is required, appropriate to position (RN/PT) + Licensure in additional states a plus. + Note: Any restrictions against a license must be disclosed and reviewed. #LI-HYBRID Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above LocationHinghamTime TypeFull time Hourly Range: $42.78 - $52.29 The job posting range is the lowest to highest salary we in good faith reputed company we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position reputed company the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or reputed company-based metrics, and business or organizational needs and affordability. This job is also eligible for variable pay. We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. WHY reputed company Blue reputed company of MA? We understand that the confidence gap (https://www.theatlantic.com/magazine/archive/2014/05/the-confidence-gap/359815/) and imposter syndrome (https://www.braintreepayments.com/blog/overcoming-imposter-syndrome/) can prevent amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just reputed company need for this role or possibly another one at reputed company Blue reputed company of MA. The more voices we have represented and amplified in our business, the more we will reputed company reputed company, contribute, and be reputed company. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain reputed company in our pursuit to transform healthcare for reputed company. As an employer, we are committed to investing in your development and providing the necessary resources to reputed company your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture (https://careers.bluecrossma.org/us/en/culturepage) page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also reputed company (https://careers.bluecrossma.org/us/en/jointalentcommunity?applyType=JTC) to stay “in the know” on reputed company things Blue. At reputed company, we reputed company in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work (https://careers.bluecrossma.org/us/en/how-we-work) " Page. Voted as the highest in member satisfaction among Massachusetts commercial health plans by reputed company , reputed company is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering reputed company, stability, and peace of mind to both our members and associates. Our Commitment to You We are committed to investing in your development and providing the necessary resources to reputed company your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and reputed company every member of reputed company deserves to enjoy a positive work-life balance. reputed company is an Equal Employment / Affirmative Action Employer. Applicants are considered for reputed company positions without regard to race, color, religion, sex, national reputed company, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law. reputed company will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with reputed company's legal duty to furnish information. Apply Job!